Class III.
Proximal surfaces of anterior teeth (incisors
and canines) without loss of the incisal edge
Diagnosis
 Visual investigation
 Transillumination
Choice of material
 Material of the first choice is aomposite
 Material of the second choice is
glassionomer
Access to the cavity
 Through the enamel from the oral or
vestibular side
 - the round diamond, obliquely from the
side of the neiborough tooth
 Removal of old filling
 Separation of teeth using wooden wedges
can be helpful
 Removal of hyperplastic gingiva
When and why oral approach
 The facial enamel is conserved for
enhanced esthetics
 Some unsupported,but not friable, enamle
may be left on the facial wall of a class III.
And IV.
 Color matching is not as critical
 Discoloration or deterioration is less visible
When and why facial
approach
 The carious lesion is positioned facially
such that facial approach would
significantly conserve the tooth structure
 The teeth are irregulary aligned, making
lingual access undesirable
 Extensive caries onto the facial surface
 A faulty restoration (originally placed from
facial approach) needs to be replaced
Oral access
Indirect vision – clean unscratched mirror
Round diamond (standard) or round carbide
bur, the size depends on size of the caries or
defective restoration.
Before contacting the tooth, the cutting
instrument is positioned for entry and
rotated at high speed using water-air apray
The point od access is within the
incisogingival dimension
Facial access
 The same steps, the procedure is simplified
because visile directly.
Cavosurface margin
 The size of the cavity depends on dental
caries, do not extend
 Margins must be visible
Design of the cavity
 Walls are perpendicular to the enamel
surface.
 Enamel must be beveled (approximately
45°) – border appr 1 mm
bevel
Flame shaped or round diamond
Dry operating field
Rubber dam
 Before placement of rubber
dam the colour choice must
be done
(colour, translucency)
The teeth become dessicated
and chalky white. It is a
reversible process.
Acid etching
30 seconds enamel
15 seconds dentin: 15/15
Bonding
Remember passive bonding after acid etching
Why acid etching?
 Enamel
- regular surface with opened
inter/intraprismatic
spaces
 Dentin
- no smear layer
- opened dentinal tubules
- collagen network
available
Final check
Filling of the cavity
 Matrix – transparent strip, wedge,
incremental technique
Why incremental technique?
Esthetics
Good conversion (curing)
Marginal integrity (C-factor)
Sequences of operation
Cleaning of teeth
Cavity preparation
Etching
 During acid etching and preparation
 the protection of adjacent tooth is necessary using
a metal or polyester strip.
Matrix and wedge, bonding
Layering of composite
Layering of composite
Before finishing
Matrix has been removed
Finishing
Polishing
Finished filling
Lesion that extends onto root
surface
 The enamel is beveled
 The wall on root surface is smoothened and
some authors recommend groove in dentin
 If not enamel – box (rounded) and GIC
Class IV.
Proximal cavities in anterior area
with loss of incisal edge
Reasons: caries or trauma
Access and preparation
 The area is visible, with rpm appr 40.000
the sharp edges are rounded using round or
flamed diamond, enamel is beveled
 Some authors leave the enamel unbeveled
on oral surface.
Cavosurface margin
Limited on defect only
Principle of retention
 Výplňovým materiálem je kompozit
 Retence mikromechanická – mikroretence
 Kotvení na rybinu je zastaralé!!!!
Retentive border
Resistance
 Composite material
 Enamel supported with dentin with
exception of labial surface
 Good polymerization
Two key factors
 Colour and form
Location of incisal edge and
the palatal wall
 Finger method
 Silicone matrix (key)
 Polyester strip (matrix band with wedges)
lroubalikova@gmail.co
m
46
Silicone matrix
Oral surface
Incisal edge
Surface texture
For oro/vestibulo - proximal surfaces -
One step poloishing – various pressure
Preparation and making fillings
Class V., III., IV.
Class V.
 Cervical defects
- Dental caries
- Non carious lesions (erosion, abrasion,
V shaped defects)
Types of defects
 Caries
 Erosion
 Abrasion
 V shaped defects
 Erosion
Choice of material
 Amalgam (posterior area)
 Composite (mainly in anterior teeth where
the defect is situated in enamel)
 Glassionomer: caries defects, esp deeper,
situated out of enamel, higher caries risk
V.Class Amalgam
 Posterior area
Access
 Elimination od the undermined enamel
- Burs or diamonds (pear), tapered fissure bur
 Separation of the gingiva– temporary filling
guttapercha, fermit, clip, zinkoxidsulfate
cement, cavit, provimat).
 Ablation of ingrown gingiva – surgical
(scalpel, laser, high frequency current)
Cavosurface margins
Gingival: axial dephth of 0,5 mm inside the
DEJ.
Extention of the preparation incisally,
Gingivally: 0,5 mm subgingivally
mesially and distally: to axial walls
Or: untill the cavosurface margins are positioned in
sound dental structure. (small cavities, good oral
hygiene)
Total dephth: 1 – 1.25 mm. If on root
surface -0,75 mm
Retention
 Box 0,75 – 1,25 mm deep, undercuts,
Depht
Gingivally: axial dephth of 0,5 mm inside the
DEJ.
Total dephth: 1 – 1.25 mm. If on root
surface -0,75 mm
Resistance
No occlusal forces
Gingival margin
Mesial and
distal margin
Occlusal margin
The bottom of the cavity follows the convexity of the crown.
Filling
Base – pulpal wall
Amalgam – portion by portion, condensor
with straight front, burnisher (spatula).
Class V. composit
 Aesthetic area
 Margin in enamel
Preparation for composite,
making filling
Cavity is limited on caries lesion only
Enamel must be beveled
Etching, priming + bonding
Placement of composite
Matrices
Transparent cervical matrices
Matrix band acc. to Belvedere
Laser
Rotační nástroj
Class V. glassionomer
 Cavities with margins in cementum
 Or also in enamel or partly in enamel (in
patients with worse level of oral hygiene)
Glassionomer
 Bonds chemically
 Realease fluoride ions
 Thermal expansion similar to dentin
 Acceptable aesthetics
Preparation for glassionomer
making filling
 Cavity is limited on carious lesion only
 Margins sholud be smoothen (no bevel)
 Conditioner (polyacrylic acid) -20 s
 Washing
 Placement of glassionomer (one bulk)
 Matrix (transparent or aluminium cervical
 matrix)
Combination of materials
 Glassionomer – replaces lost dentin
 Composite – replaces lost enamel
base of glassionomer
Composite
Connection
Glassionomer – tooth:
chemical
Composite – tooth:
micromechanical
Composite – glassionomer
Micromechanical.
Choice of materials
Glassionomer Combination Composite
Or amalgam in posterior area